Listen to what your friend is saying. That will give you a sense of what the loss means to your friend and help you to decide how to respond. If your friend says, "We were so excited about the baby," acknowledge the loss of her hopes and dreams for the baby. If she says, "I can't believe this happened," acknowledge her shock and disillusionment. If you don't know what to say (or if you friend is crying so much that you can't pick up any cues from what she's saying), simply say, "I'm sorry."

It's important to listen and pick up on the signs your friend is giving off as to how she is experiencing the loss. Don't be afraid to ask questions and let your friend tell you her story. This is so individual to the circumstances surrounding the pregnancy. Many women will grieve a miscarriage deeply and for a long period of time, as a death — others may feel differently about the loss. For instance, one woman might be eager to try again and become pregnant soon after a miscarriage while another may feel there's no way she could make herself vulnerable to loss again anytime soon. [...] The important thing: Listen to your friend and don't be afraid to ask her how she feels about the loss. Her answer may be different — and more intense — than you had imagined.

One of the worst things you can say is "you can always try again." When a woman and her partner are grieving the loss of a baby, it is little comfort to essentially be told that they can replace this baby with another one. The same holds true for statements like, "at least you have other children."

Douglas agrees, adding, "Right now, your friend doesn't want another baby. She wants the baby she was carrying." She also offers a few other phrases to avoid:

"At least you didn't have a chance to get attached to the baby." (Your friend started to get attached to the baby the moment she began to get excited about her pregnancy. That's why she's so devastated right now.) [...]

"It wasn't really a baby. You were hardly pregnant at all." (It was the beginning of a baby. And your friend was already planning ahead, thinking about the joyous times she would share with her child after the birth.)

"These things happen for a reason. It was for the best." (Yes, miscarriages do happen for a biological reason, but that's not any comfort to your friend, who is hurting as a result of her loss. You would never say this to a friend whose parent just died, so why say it to a friend who has just experienced a miscarriage?)

Remember that you may not know how she feels.

Douglas advises against saying "I know how much it hurts," unless you actually do. She explains, "If you have been through a miscarriage (or your partner has been through a miscarriage), let the person know that you understand how much it hurts. They will feel a little less alone." However, Lanham cautions that "even if you have experienced a miscarriage yourself, it is presumptuous to assume that you know how someone else is feeling about their loss." You can share your experience with your friend, but it might be best not to assume that you know exactly what she's going through.

If you hear about the miscarriage second-hand, be cautious.

When you hear second-hand that a friend or acquaintance has miscarried, you may want still want to give your condolences. But tread carefully. Gross explains,

This depends on how you hear the news. If the friend told a mutual friend in confidence who then happens to share the information with you, I would hesitate to bring this up first. After my miscarriage, I wouldn't have wanted to feel like there were people who knew about my loss outside of my inner circle. But in a situation where the pregnancy had already been announced, and so the loss of the pregnancy is clear, I would say definitely do bring it up with her. With someone you don't know well, express your sympathy and concern but do be conscious of bringing this up at the right time and place. I wouldn't want to see a grieving woman bombarded by questions or even sympathetic wishes at the water cooler.

Send a card.

Everyone I talked to said that (unless, as above, the miscarriage is a private matter you're not necessarily supposed to know about) it's a great idea to send a condolence card. Says Lanham,

[I]n most cases, a friend would very much appreciate a card letting her know that you care and are available to listen and offer support. A card would also be a good way to discreetly reach out to an acquaintance if you feel inspired to do so. Cards specifically written for those who have had a miscarriage are a sensitive and caring way to express your sympathy.

Douglas adds,

A note with a few well-chosen words acknowledging the loss can be tremendously comforting to friend or acquaintance who has just experienced a miscarriage. Your friends won't have very many other mementoes of her pregnancy. She'll be able to hold your card and reflect on your words on those lonely nights when her arms feel unbearably empty.

Follow up.

This advice comes from Gross, who adds,

Keep asking about how your friend is doing. Grief comes in waves and stages and how she feels immediately after her miscarriage may be very different from how she feels weeks or months afterwards. [...] Don't assume that your friend is out of the woods with her grief just because a couple of months have gone by. Give her the room to talk to you about her feelings — to cry, to be angry, to be sad, to miss her baby. (And she very well may use such language.) Also give your friend the room to move on, to embrace a new pregnancy or the decision not to try again. Understand why coming to your child's birthday party or your baby shower might be torture for her, but don't push her away by not including her in these events either. Let her decide and let her know how much you love and support her no matter what.

Lanham agrees:

Don't assume that she will get "over it" quickly. Continue to offer support in the weeks and months following the loss, and even when she is pregnant again. I remember how much I appreciated those friends who continued to acknowledge the loss of my son, even when I was expecting my second child. While it's true that I was happy about my subsequent pregnancy, I was still grieving.

The aftermath of the miscarriage can be incredibly difficult, but the help of friends can make it easier. Gross recommends you ask yourself, "How can you help? Can you leave a home cooked dinner on your friend's door once a week? Babysit her other kids so she can take time to recover? Take her to coffee and let her cry for an hour?" Your support will ease your friend's path to recovery, even if that path is a long one.